CoQ10's Role in Fibromyalgia and ME/CFS

Increasingly, research is showing that CoQ10 depletion is a key factor in FM and ME/CFS and that supplementation with CoQ10 can significantly improve symptoms.

Coenzyme Q10 (CoQ-10) is a vitamin-like nutrient that is present in virtually every cell of the body.

CoQ10 is an essential component of each cell's ability to produce energy.

It is also a powerful antioxidant – a chemical that "mops up" potentially harmful substances.

In order to understand how CoQ-10 works, it is first necessary to understand the mitochondria. Mitochondria are the energy producers in each cell that enable the cells to function properly. It is the job of the mitochondria to supply this energy in the form of adenosine triphosphate (ATP). This is where CoQ-10 comes in. CoQ-10 is the catalyst that makes it possible for the mitochondria to produce ATP, the molecule upon which all cellular functions in the body depend.

Since the mitochondria play such a key role in the function of all cells, it seems logical to think they may be implicated in diseases like fibromyalgia and ME/CFS. As it turns out, research is proving that mitochondrial dysfunction and low levels of CoQ10 do indeed play an important role in these illnesses.

The CoQ10 – Fibromyalgia Connection

A team of Spanish scientists have led the way in identifying the role CoQ10 plays in fibromyalgia. In a 2009 study, they found that CoQ10 levels were 40% lower in fibromyalgia patients than in healthy controls. (1) A follow-up study in 2010 confirmed that FM patients have reduced levels of CoQ10 and determined that mitochondrial dysfunction is a key factor in the disease.(2)

The research team has since gone on to test the effectiveness of CoQ10 supplementation on fibromyalgia symptoms. In 2013, they gave 20 FM patients 300 mg/day of CoQ10 for 40 days. They found that “An important clinical improvement was evident after CoQ10 versus placebo treatment...” The patients receiving the CoQ10 showed significant improvements on the Fibromyalgia Impact Questionnaire (FIQ). The most prominent reductions were found in the pain, fatigue and morning tiredness subscales of the FIQ.(3)

The CoQ10 – ME/CFS Connection

When plasma CoQ-10 was analyzed in 58 ME/CFS patients and 22 normal controls, researchers found that CoQ-10 levels were significantly lower in the ME/CFS patients than in the normal controls.(4) This finding has far greater implications than the obvious lack of energy experienced by people with ME/CFS. Because CoQ-10 is essential to every cell in the body, a severe CoQ-10 deficiency can cause mitochondrial dysfunction, which in turn has a serious negative impact on multiple organs and body systems and can ultimately result in heart failure.

In fact, that is exactly what happens, according to Dr. Sarah Myhill, MD, a UK-based ME/CFS researcher and clinician. In her paper, "Chronic Fatigue Syndrome and Mitochondrial Dysfunction," she makes her case that ME/CFS is actually a symptom of mitochondrial failure.(5) Dr. Myhill recommends that ME/CFS patients have their CoQ-10 levels checked and begin taking CoQ-10 supplements if they are low. She also notes that CoQ-10 will work best in conjunction with acetyl L-carnitine, magnesium, D-ribose and Vitamin B3 (niacinamide).(6)

CoQ-10's Role in Other Diseases

Because a deficiency of CoQ-10 can potentially affect every cell in the body, more and more research is being done to determine how much of a role it may play in other illnesses. Animal and/or preliminary human studies have been conducted to uncover how CoQ-10 may work in managing a number of diseases including: breast cancer, melanoma, Parkinson's disease, Huntington's disease, Alzheimer's, and migraines.(7-11) All have had promising results indicating that CoQ-10 may be helpful in supporting the prevention or treatment of those diseases.

How Do We Get CoQ10

Small amounts of CoQ-10 can be found in foods, primarily meat and fish. The highest amounts are found in organ meats (heart, liver, kidneys) as well as beef, soy oil, sardines, mackerel and peanuts. CoQ-10 is also synthesized in bodily tissues. In healthy individuals, the combination of dietary intake and biosynthesis work to maintain normal CoQ-10 levels.

Then why do so many people seem to be deficient in CoQ-10? No one knows for sure. There are likely multiple causes. Perhaps the emphasis in recent years on eating less red meat as well as generally poor eating habits have contributed to reducing our dietary intake of CoQ-10. And a number of other factors, such as environmental toxins, chronic diseases and some prescription medications may contribute to the impairment of the body's ability to synthesize CoQ-10.

For example, research has shown that the cholesterol-lowering drugs known as "statins" (Lipitor, Zocor, etc.) not only lower cholesterol, but also inhibit the biosynthesis of CoQ-10 by as much as 40%.(4) Anyone taking medication to lower cholesterol should seriously consider also taking CoQ-10 supplements.

Other types of medications thought to deplete the body of CoQ10 include beta-blockers, diuretics, tricyclic antidepressants, and diabetes medications such as metformin, tolazamide and glyburide.

When our bodies are not maintaining adequate CoQ10 levels – for whatever reason – supplementation may become necessary.

What Type of CoQ10 is Best

The CoQ-10 found in most supplements is called ubiquinone. In order to produce cellular energy, the body must convert the ubiquinone to ubiquinol. It is the ubiquinol that carries electrons through the mitochondria and produces energy.

Young healthy people can easily convert CoQ-10 to ubiquinol. But as we age or when we have a chronic illnesses, our ability to convert CoQ-10 to ubiquinol diminishes. This decreased ability becomes apparent around the age of 40, although some scientists suggest that it may begin in the early to mid-20s.

Ubiquinol's superior effectiveness on the degenerative consequences of aging was demonstrated in a 2006 study published in Experimental Gerontology. Age-accelerated mice were divided into three groups. The first group was fed a standard diet with no supplementation. The second group received a standard diet plus the ubiquinone form of CoQ-10. The third group ate a standard diet plus the ubiquinol form of CoQ-10.

After a year, the first group suffered severe, degenerative changes related to aging. The second group, those receiving the ubiquinone, showed noticeable, but less harsh changes. The third group, who received the ubiquinol, remained alert and energetic, exhibiting the characteristics of young, healthy mice.

Overall, the ubiquinol group aged 51% slower than the group receiving no CoQ-10 and 40% slower than the ubiquinone group.(12)

Another peer-reviewed study compared how well humans absorbed ubiquinone and ubiquinol. The results showed that it takes 8 times as much ubiquinone to equal the blood plasma concentrations of ubiquinol. More specifically, 150 mg. of ubiquinol was equal to 1200 mg. of standard CoQ-10.(13)

Additionally, in an unpublished study with aged rats, blood concentrations were sustained longer with ubiquinol. After eight hours, the concentration of ubiquinol CoQ-10 was 3.75 times greater than standard CoQ10.(14)

Any type of CoQ10 is good but as these studies indicate, it is probably better to give the body CoQ-10 in the form it can most readily use – ubiquinol. It's important to note that healthy individuals under the age of 25 can easily convert standard CoQ-10 to ubiquinol, but if you are over 25 or have a chronic illness, ubiquinol is the recommended form of CoQ-10.

How to Take CoQ-10

Most fibromyalgia and ME/CFS specialists recommend CoQ10 to their patients. The doses vary from 300 mg/day up to 1200 mg/day. Evidence indicates that doses up to 1200 mg/day and perhaps even higher are safe and no side effects have been reported.

If you are taking standard CoQ10, it should be taken with a high-fat meal in order to be properly absorbed. However, Ubiquinol CoQ-10 bonds with water, making it easier to absorb and eliminating the need to take it with fatty foods.

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Karen Lee Richards is a Health Guide specializing in Fibromyalgia and ME/CFS, for HealthCentral's Chronic Pain site (www.chronicpainconnection.com). Karen is co-founder of the National Fibromyalgia Association (NFA) and was Executive Editor of Fibromyalgia AWARE magazine for four years.

14. Kaneka Corporation study. “Treadmill test with the aged rat at age of 61-63 weeks.” 2006.

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Note: This information has not been reviewed by the FDA. It is general and is not meant to prevent, diagnose, treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

I personally take three supplements to combat fatigue: CoQ10 (Ubiquinol), NADH, and high-dose Vitamin B-1 (thiamine). The combo works very well for me and I can definitely tell a big difference if I stop taking one of them.

Here are articles I wrote about NADH and high-dose thiamine:

"Running on Empty? Fuel Up with NADH"
http://www.prohealth.com/library/showArticle.cfm?libid=16344